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. � � <br /> See.13.04 RIGATS OF StlSJECIS OF DATA ' <br /> Sabd. 1. Trpe o[data. ?he righcs o!individuai on whom the data is smced or oo be scored shall be as sec focth in this secdon. <br /> � Subd.2. Information nqirired to be�irm individual. An individuaI ulced to suppty prirate or coahdendal daa concerning himsetf shall <br /> be iaformed of: (a)the purpose and iarended use of che requuud dan wichia the collecang 3nre ageary.politial subdivisian.or samwide sysLm; <br /> (b)whe�e:he taay roEuse oti u legaUy requ'u:d co suppty_che requesred daa:(e)any I�owa caasequence uisiag frvm dis sizpplying or rettesiag to suppty <br /> privace or eon.�tdar.ca!daa;u:d(�the ideariry of oc�er ptrsoas or eaddes auchocized by st3ce er fedenl law ta rtceive cio�a. ihis requiremenc sha1I <br /> aot appiy wEen aa iGdividaal is uked w supply iavesrigadve dan,punvaac oo seedon 13.82.subdivisioa 5,w a law eafocoemeac officec. • . • <br /> '[he eoc�missione�of revenue mav olaca the nodc- rauird und-�this subdivision in the individual ineome ax ot orooectv taz refund <br /> inscsucdons inscexd of on chose forms. • <br /> Subd.3. Accas to data bv lndirtdual. Upon request oo a respacuible aurhodry.an'mdividual sball be intormed whutserhe is rhe subjecc <br /> o[stor.d daa on iadtviduals.aad whechcr ic is class�ed u public,pdva�s or conF.deadal. Upon his tlu�her request,ae jedividaal who Is che subje:t <br /> of swred pcivace or public daa on iudividuals shal!be showa the daa wi�hauc any eharge to him aad;if he des'ues,ehall be infocmed of du eoacenc <br /> and meaaiag of that daa. Afcec an individuai has been showa the priva�e dara and iafocmed o[iet meaning.the dam ne:d not be discloud oo hua to� <br /> six monrhs thereahec uniess a d'upute or acdon pursuant to this secdon is pending or addidonal daca on the individuai has beea eoUeued or erea�d. <br /> The respoeuible auehociry shallprovide eopies ot�he pciva�or public daa upon requuc by�he iadi�idua!subject o[�he daca. The nspoasi'ble auchoriry <br /> may requir: the tequadng person to pay[he accual coscs of maki�g,cecritying,and eemp'�ling the copia. <br /> The responsible authoriry shall compiy imraediacety.if possible.wich any request made pursuant to this subdivision.or wichiu hve days of <br /> the dace of the teqaes4 eactuding Suucdays,Sundays and legal holidays,if irsunediate compliaace is noc possible. If he cannot eompiy wich the�equest <br /> wi�hin that dme,he shatl so infocm the individual.and may have an addiaooaI fve days wirhia which oo eomply wi�h the requesc,excludiag Satuidays, <br /> Sundays aad kgal holidays. . . <br /> Subd.4. Procedure when data is not accurate or eomplete. M iadividual may eoncest the accunry or completeaeu of publIc or private <br /> daa concecning htmself. To execcise this right,an indivtdual shaIl aoaFy in wridag dse nesponsibie authoriry desctibing the nawre of die d"uagreemeac <br /> The respoasiblo authoriry shall wi�hin 30 days ei�:er. (a)correcc che data[ound to be inaccunte or iacomptete and atcempc to norify past recipierus of <br /> inaecucdte or Ineomptece daea.jnetuding recipien�s named by�he individuat:or(b)aoafy rt►e individual thac he believes the data to be cocceet Dati <br /> ia dispuce shall be disclosed only If the tndividnal's statemenc o[d'�sagreemeac is included wirh the disclosed data. <br /> The decerrninaaon of the responsible aurhoriry may be appealed pursuanc to the provisions of�he adminisaadve pcocedu�e aet relaaag to <br /> eantesced ea�as. � . . � <br /> DATA PRIVACY ADVISORY � <br /> In accordance with M.S. 13.04,Subd.2, "Ri�Q.hcs of subjecu of data",we would like to iaform you that your request <br /> for a permit or license from the Ciry of Orono or any of iu departments may require you to furnish certain private or <br /> confdential information. <br /> You aze notified that: <br /> 1. The informatioa you furaish will be used to detormine your qualification for the permit or license requated. <br /> 2.. You may refuse to suppiy data, but rafusal may require that the Ciry deny the permit or license. � � <br /> 3. The information may be shazed with other local,stace or federal agencies to the ettent necessary to process <br /> the permit or license. � <br /> 4. If your requested permit or license requira Council action to approve, some iaformation may become <br /> . public, . . . . . . . � <br /> �5. You have certain rights under M.S. I3.04�(availabie upon request) to review private data on.yourself. . . <br /> 6. Your full name is required to process this application or permi[. <br /> � s,.�, k�,► <br /> Fust �� �tiddle t • <br /> /�C� -�� ^�t.�� <br /> Add <br /> �tc �. .c�r.o � �� 5.�33 ( P'7f� `y_S 6 � . <br /> Ciry Scue Zip Phoae <br /> I undetstand rights state abdve. <br /> Signacur <br /> � <br />